Developing the PROMISE European Guidelines

for Training Health and Social Care Professionals in Mental Health Promotion

Tim Greacen, Emmanuelle Jouet Etablissement public de santé Maison Blanche, Paris

PROMISE Conference, London13 September 2012

• Develop and disseminate guidelines for training professionals with respect to Mental Health Promotion

• Develop specific applications with respect to mental health promotion, including in areas traditionally addressed by health prevention approaches: suicide and depression; alcohol and drug use.

• Involve mental health service users in developing these training programmes

Aims

Priority Area: 2 PROMOTE HEALTH (HP-2008)◦ Action: 2.3 Improving mental health and healthier

living

DG SANCO EAHC

2009 - 2012

PROMISE: a DG SANCO Project

• Middlesex University (MU), London, UK• Hôpital Maison Blanche (HMB), Paris, France• Dept Education, County of Aarhus, Denmark• University of Ljubljana (UL), Slovenia• University of Primorska (UP), Slovenia• Hungarian Institute of Occupational Health

(OMFI), Budapest, Hungary• Municipal Institute of Medical Research

Foundation (IMAS-IMIM), Barcelona, Spain• University of Molise (UNIMOL), Molise, Italy

Partners

Overview of Method

1. Build a Scientific Committee across all EU PROMISE project sites

2. Develop a common scientific culture3. Study the reality at the 8 sites4. Study the literature on training in mental health promotion to

identify quality criteria for training professionals in MHP: the PROMISE European Guidelines

5. Test the Guidelines 1. by adapting them to three health themes, including traditional mental

health prevention themes2. by adapting them to four health & social care professions3. in case studies

Step 1: Building the Generic Scientific Committee

◦ Made up of site researchers different professional backgrounds:nurses, GPs, social workers,

researchers, risk reduction experts, psychologists, psychiatrists, educational scientists…

different institutions: universities, hospitals, public health… different cultures: 8 different nationalities value these differences as a source of richness.

◦ Developed a common scientific culture on MHP Introductory 2-day training on MHP read and analysed 12 key EU + WHO policy & research

documents produced first set of guidelines (GG1.0)

◦ Referred to local scientific committees including users and training experts

◦ Sought regular feedback from local committees, outside experts, stakeholder groups; integrated feedback into guidelines

The Generic Scientific Committee

AARHUS: Bettina Hansen BARCELONA: Eithne Leahy BUDAPEST: Zoltan Cserhati KOPER: Ksenija Mavaric Da Silva LJUBLJANA: Amra Sabic, Vera Grebenc LONDON : Chris Griffiths MOLISE: Angela De Marco PARIS: Tim Greacen, Emmanuelle Jouet

Step 2: Developing a Shared Scientific Culture

Outcome of the 2 day initial training

*** Improved knowledge on MHP and the difference between promotion & prevention

*** Acquired skills in designing MHP projects *** Felt that we were part of a group and that we

had common goals

* Understood the importance of professional diversity and working in mixed professional groups to build successful projects

* Identified common values

A series of delicate questions identified

• distinguishing MHP from physical health promotion, identifying areas of overlap. ◦ e.g. when do “physical exercise” or “sleep” become mental health

promotion issues? When are they physical health promotion issues?

• distinguishing MHP from mental illness prevention ◦ identifying areas of overlap◦ understanding how “promotion” is a new paradigm that includes

and transcends “prevention”◦ understanding how old notions such as primary, secondary and

tertiary prevention have evolved in recent years◦ understanding why older notions such as “mental hygiene” came

to be replaced by theories of “prevention”• understanding that all health interventions have positive

and negative outcomes: what might be the risks in MHP?• understanding the ethical problems

◦ distinguishing MHP from social control, policing, religion, governmentalisation and politics

◦ who defines what is “good” health and what is “bad” health?◦ who has vested interests in this area?

1. Each country has a national institution which has MHP on its agenda (i.e. that publishes recommendations on MHP)

2. Apart from Middlesex, where a policy existed on training professionals on MHP (and not just on MHP itself), all respondents consider that local policy on training professionals on MHP is insufficient.

3. Experience varies with regard to employing users or professionals with user backgrounds as trainers for professionals

None: OMFI (Budapest)

Only a little: HMB (Paris) and IMAS (Barcelona)

Systematic: PDCA (Aarhus), MU (London), FSD (Ljubljana)

Step 3: study the reality of MHP training at the 8 PROMISE sites: What was the situation in 2009?

Existing MH promotion & MH prevention training at PROMISE sites in 2009

Drug & alcohol prevention

Smoking prevention

Eating well

Keeping fit Sleeping well

Stress prevention

Suicide prevention

Depression prevention

PTSD prevention

Problem-solving skills

PDCA No YES No YES YES YES YES YES

OMFI No No No No No No No No No No

FSD No YES No No No No No No No No

MU YES YES YES YES YES YES YES YES YES No

Molise- NO No No No No No No No No No

HMB YES YES YES No No No YES YES No YES

Existing MH promotion & MH prevention training at PROMISE sites in 2009

Resilience building skills

Child mental health promotion

Relaxation skills

Meditation skills

Parenting skills

Counselling for mental health issues

Preventing pathological gambling

Preventing cyberdependence

Prevention of violence

Fighting discrimination and stigma

Others (please list)..

PDCA YES No YES No YES No No No No YES No

OMFI No No No No No No No No No No No

FSD No No No No YES YES No No YES

MU YES YES YES YES No YES YES No No YES YES

Molise No No No No No No No No No No No

HMB No No YES No No No No No No YES No

All sites analysed major European policy and scientific literature reviews and some international documents on MHP to identify quality criteria on training in MHP

12 documents studied in four steps using standard qualitative thematic analysis techniques◦ Create an initial document analysis template (DAT) based

on PROMISE Project objectives◦ Use DAT to collect relevant information from major

literature reviews and policy documents on MHP◦ Keep on going until saturation: no new codes identified◦ Group into over-arching themes: the PROMISE quality

criteria

Step 4: Study the literature

The 12 documents

1. The European Pact for Mental Health and Well-being 2. Imhpa : Mental Health Promotion and Mental Disorder Prevention: A Policy for Europe3. Mindful: Mental Health Information and Determinants for the European Level4. NICE 2007: Public health interventions to promote positive mental health and

prevent mental health disorders among adults5. Promo: Best Practice In Promoting Mental Health In Socially Marginalized People In

Europe. Queen Mary University of London; 2008. 6. Imhpa Country Stories: Mental health promotion and mental disorder prevention

across European Member States: a collection of country stories7. Consensus Papers and Policy Briefs of The European Pact for Mental Health and Well-

being 2008:8. WHO: Prevention of Mental Disorders: effective interventions and policy options9. WHO: Promoting Mental Health: concepts, emerging evidence, practice10. Imhpa: The evidence of mental health promotion effectiveness: strategies for action. 11. Lancet : Treatment and prevention of mental disorders in low-income and middle-

income countries12. Canada: Community Capacity Building and Mobilisation in Youth Mental Health

Promotion

Document analysis template Version 1

(tested on the European Mental Health Pact) Read the following test document: the European Mental Health Pact,

http://ec.europa.eu/health/ph_determinants/life_style/mental/docs/pact_en.pdf and answer the following survey for this document (Hint! Use Control F, with key words such as “training” or “people with mental health problems” or “professionals” to search for your answers)

◦ Does the document talk about training professionals on mental health promotion?

◦ Please list the recommendations for training professionals on mental health promotion that you can find in this document.

◦ Which professionals are to be trained?◦ How much time and resources for training these different professions?◦ Is this initial training or continuous training?◦ How do users participate in the recommended training of professionals

in MH promotion ?◦ Does it talk about carer (“carer” = friends and family) participation?◦ Can you identify standards or criteria for good training of professionals

for mental health promotion that are mentioned in the document?◦ What else can we draw from this document that might be useful for

creating guidelines for training professionals in mental health promotion?

◦ What do you personally think about this document? Did you learn anything?

Building the Guidelines (1/2) All sites analysed all major European and some international

documents on MHP to identify quality criteria on training in MHP

Survey of European stakeholder groups points of view

Identifying overarching themes (from 50 quality criteria to 10)

Intranet survey of Barcelona professionals on the use of the media in mental health promotion

Integrate findings from sister European project, CompHP

GG.1.0

GG.1.1

GG.2

GG.2.3

GG.3

GG.0

Building the Guidelines (2/2)

Integrate feedback from training experts at all sites

Test guidelines in case studies at all sites

Test guidelines in adaptations for specific professional groups: psychiatrists, nurses, social workers, psychologists

GG.4.1

GG.4.2

GG.5

How are the PROMISE European Guidelines structured?

Built around 10 quality criteria for designing training programmes ◦ Training on MHP in general

or on specific MHP themes addressing specific populations

or for training when setting up MHP projects◦ a focus on health and social care professionals◦ with specific adaptations for undergraduate and

postgraduate training

◦ First, build your training programme◦ Then look at each of the 10 quality criteria◦ Does my training programme respect this quality

criterion? If it does, move on to next criterion If not, look more closely at the quality criterion in

question. Use the resource kit attached to each quality criterion for

legal texts, examples, training ideas, posters, slides, etc. as well as a short checklist.

Then modify their training programme so that it does respect the quality criterion in question. 

How should a training designer use the PROMISE Guidelines?

The 10 PROMISE Quality Criteria 1. Embracing the Principles of Mental Health Promotion

The training programme embraces the idea of mental health promotion as distinct from mental illness prevention or curative care. Positive mental health is seen as a resource, as a value on its own and as a basic human right essential to social and economic development. Mental health promotion aims to impact on determinants of mental health so as to increase positive mental health and to reduce inequalities.

  2. Aiming for Community Participation and Empowerment

The training programme embraces the principle of community participation. Mental health promotion involves encouraging and empowering all community stakeholders in mental health promotion in general or in developing specific mental health promotion projects. In the case of training professionals for specific mental health projects, representatives from the populations directly concerned by the mental health promotion objective in question are encouraged to participate in fixing the health objectives and designing and delivering the programme. The training programme also takes into account how the populations concerned are going to be able to resource their health promotion in a sustainable way (finance, time, etc.).

3. Adopting an Interdisciplinary and Intersectoral Approach

The training programme takes into account the necessarily interdisciplinary and intersectoral approach to mental health promotion. It aims for all stakeholders to have collective ownership of the training programme and of the mental health promotion interventions associated with the programme

The 10 PROMISE Quality Criteria

4. Including People with Mental Health Problems

The training programme applies its objectives also to people with experience of mental health problems, mental health service users and their carers. People with mental health problems and, in the case of training related to a particular mental health promotion programme, people with mental health problems related to the programme objective, are included from the outset.

5. Advocating

The training programme underlines the importance of advocacy, i.e. knowing how to bring out and defend the point of view of people who may not have the skills or the social power necessary to defend themselves or, in the policy arena, working for positive change in the social or health care system environment.  

6. Consulting the Knowledge Base

The training programme takes into account up-to-date scientific evidence and ethnographic information, drawing from a variety of methods, including epidemiology and social sciences, for identifying action strategies.

The 10 PROMISE Quality Criteria

7. Adapting Interventions to Local Contexts and Needs in a Holistic, Ecological Approach

The training programme is built around health promotion objectives that are based on the assessment of local needs and measurable. Interventions need to be adapted to local contexts, treating specific mental health objectives in a holistic way from the individual’s and from the community’s perspective, and taking into account people from different cultural, socio-economic and educational backgrounds and of different ages, genders, sexual orientation, health status and abilities. The communities or individuals in question participate in assessing local needs, choosing objectives and indicators, and measuring the results.

8. Identifying Risks

The training programme addresses not only the expected positive outcomes but also the possible risks of the mental health promotion intervention(s) being presented for both individuals and communities.

9. Using the Media

The training programme integrates a media and communication strategy in promoting mental health and fighting against stigma associated with mental illness.

10. Evaluating Training, Implementation and Outcomes

The training underlines the importance of evaluating mental health promotion training outcomes as well as actions and programmes in general.

http://promise-mental-health.com/quality-criteria.html

Greacen T, Jouet E, Ryan P, Cserhati Z, Grebenc V, Griffiths C, Hansen B, Leahy E, Maravic da Silva K, Šabić A, De Marco A, Flores P. Developing European Guidelines for Training Care Professionals in Mental Health Promotion, BMC Public Health 2012 (submitted)

The PROMISE European Guidelines

MERCI!